Racial and ethnic disparities associated with abnormal cervical cancer screening follow-up (391)

Abstract

Objectives: There have been significant advances in cervical cancer screening since the implementation of Pap testing, with an initial decrease in incidence and mortality. Unfortunately, during the last decade, there has been a plateau in the incidence and mortality associated with cervical cancer. One of the areas largely contributing to this plateau is the low rate of follow-up with abnormal cervical cancer screening. The objective of this study was to determine whether race affects patient adherence to follow-up for colposcopy after abnormal cervical cancer screening. Methods: This retrospective chart review included randomly selected women from patients presenting to our colposcopy clinic from January 2019 to December 2019. Inclusion criteria included females aged ≥21 years old and appropriate referral for colposcopy. Patients were grouped into three categories: 1) ADHERENT to follow-up if they came to their scheduled appointment; 2) DELAYED if they presented more than three months from their original referral (usually missing 1-3 appointments); and 3) NOT ADHERENT if they did not show for their appointment after referral. Analysis was performed using SPSS v.26. Results: A total of 312 women met the inclusion criteria for the study. The majority of women were Black (65.2%), followed by non-Hispanic White (20.0%) and Latinx (14.8%). Overall, 39.1% of women were ADHERENT, 18.6% were DELAYED, and 42.3% were NOT ADHERENT. There was a significant difference between race/ethnic- ity and timing of follow-up (p=0.04). Black patients were more likely to be NOT ADHERENT for their appointment (45.6%; p=0.03), and Latinx and Black patients were the most likely to be DELAYED (21.7% and 20.3%; p=0.04) than White patients. A Black woman presenting for care would follow-up 80.0% of the time for further evaluation or treatment. Patients with private insurance were more likely to be ADHERENT for care compared with uninsured patients (77.8 vs 27.6%, p=0.001). Conclusions: There are large gaps in adequate follow-up after an abnormal Pap test across race/ethnicity; however, adherence to follow-up is lower in Black patients despite their screening rates being higher than non-Hispanic White patients. Moreover, a quarter of Latinx and Black women presented in a delayed fashion. Culturally relevant assessments and interventions are needed to understand these gaps in care. Objectives: There have been significant advances in cervical cancer screening since the implementation of Pap testing, with an initial decrease in incidence and mortality. Unfortunately, during the last decade, there has been a plateau in the incidence and mortality associated with cervical cancer. One of the areas largely contributing to this plateau is the low rate of follow-up with abnormal cervical cancer screening. The objective of this study was to determine whether race affects patient adherence to follow-up for colposcopy after abnormal cervical cancer screening. Methods: This retrospective chart review included randomly selected women from patients presenting to our colposcopy clinic from January 2019 to December 2019. Inclusion criteria included females aged ≥21 years old and appropriate referral for colposcopy. Patients were grouped into three categories: 1) ADHERENT to follow-up if they came to their scheduled appointment; 2) DELAYED if they presented more than three months from their original referral (usually missing 1-3 appointments); and 3) NOT ADHERENT if they did not show for their appointment after referral. Analysis was performed using SPSS v.26. Results: A total of 312 women met the inclusion criteria for the study. The majority of women were Black (65.2%), followed by non-Hispanic White (20.0%) and Latinx (14.8%). Overall, 39.1% of women were ADHERENT, 18.6% were DELAYED, and 42.3% were NOT ADHERENT. There was a significant difference between race/ethnic- ity and timing of follow-up (p=0.04). Black patients were more likely to be NOT ADHERENT for their appointment (45.6%; p=0.03), and Latinx and Black patients were the most likely to be DELAYED (21.7% and 20.3%; p=0.04) than White patients. A Black woman presenting for care would follow-up 80.0% of the time for further evaluation or treatment. Patients with private insurance were more likely to be ADHERENT for care compared with uninsured patients (77.8 vs 27.6%, p=0.001). Conclusions: There are large gaps in adequate follow-up after an abnormal Pap test across race/ethnicity; however, adherence to follow-up is lower in Black patients despite their screening rates being higher than non-Hispanic White patients. Moreover, a quarter of Latinx and Black women presented in a delayed fashion. Culturally relevant assessments and interventions are needed to understand these gaps in care.